Dietary inadequacy is associated with anemia and suboptimal growth among preschool-aged children in Yunnan Province, China

This study documented the relationships among dietary intake, growth failure, and anemia in a convenience sample of 172 children aged 1 to 5 years in rural Yunnan Province, China. We hypothesized that most children would have suboptimal intakes of key nutrients associated with child growth and anemia and that undernutrition would be more common in children with poor growth and in those who were anemic. Nutrient intakes from three 24-hour recalls were compared with the Dietary Reference Intakes. Height/length and weight were compared with World Health Organization Child Growth Standards to determine if children were malnourished (z score < −2 SD median). Blood was tested for anemia (hemoglobin <110 g/L). Stunting, underweight, wasting, and anemia were present among 44.4%, 15.7%, 1.7%, and 35.4% of children, respectively. The percentage of children not meeting the estimated average requirement for zinc, vitamin A, iron, and protein or the adequate intake for calcium was 87.2%, 80.8%, 66.3%, 7.6%, and 100.0%, respectively. Altogether, 19.2% and 78.5% of children were below the acceptable macronutrient distribution range for percentage of energy from protein and fat, respectively. More stunted than not stunted children were below the estimated average requirement for vitamin A, as were more anemic than nonanemic children. Growth faltering combined with findings of anemia and suboptimal intake of a variety of nutrients suggests a high prevalence of chronic dietary inadequacy among preschool-aged children in Yunnan Province. Consuming more protein-, fat-, zinc-, iron-, and vitamin A-rich foods may improve growth and reduce anemia.     

Newborn length predicts early infant linear growth retardation and disproportionately high weight gain in a low-income population

Background

Stunting is prevalent by the age of 6 months in the indigenous population of the Western Highlands of Guatemala.

Aim

The objective of this study was to determine the time course and predictors of linear growth failure and weight-for-age in early infancy.

Study design and subjects

One hundred and forty eight term newborns had measurements of length and weight in their homes, repeated at 3 and 6 months. Maternal measurements were also obtained.

Results

Mean ± SD length-for-age Z-score (LAZ) declined from newborn − 1.0 ± 1.01 to − 2.20 ± 1.05 and − 2.26 ± 1.01 at 3 and 6 months respectively. Stunting rates for newborn, 3 and 6 months were 47%, 53% and 56% respectively. A multiple regression model (R² = 0.64) demonstrated that the major predictor of LAZ at 3 months was newborn LAZ with the other predictors being newborn weight-for-age Z-score (WAZ), gender and maternal education ∗ maternal age interaction. Because WAZ remained essentially constant and LAZ declined during the same period, weight-for-length Z-score (WLZ) increased from − 0.44 to + 1.28 from birth to 3 months. The more severe the linear growth failure, the greater WAZ was in proportion to the LAZ.

Conclusion

The primary conclusion is that impaired fetal linear growth is the major predictor of early infant linear growth failure indicating that prevention needs to start with maternal interventions.     

Surveillance for cystic fibrosis-associated hepatobiliary disease: early ultrasound changes and predisposing factors

OBJECTIVE: To investigate routine ultrasonography (US) as an early marker and to identify risk factors for the development of cirrhosis and portal hypertension (PHT) in cystic fibrosis (CF). STUDY DESIGN: A cohort of 106 children with CF aged 5.9+/-2.3 years were followed for 10.4+/-0.2 years in a CF clinic. RESULTS: At enrollment, the US was normal, but biochemical and/or clinical disease was present in 10%. By the end of the study, 19 had developed US changes, eight with evidence of PHT. At the time of the initial US change, only 36.4% of those had, at the end of the study, either a heterogeneous or a nodular parenchyma, and only 50% of those with PHT had biochemical and/or clinical disease. Of the 30 patients treated with ursodeoxycholic acid for biochemical and/or clinical disease with (n=15) and without (n=15) associated US changes, PHT developed in six of the former and two of the latter. Univariate analysis and logistic regression showed that children with more severe disease in terms of forced expiratory volume in one second were at somewhat greater risk (P<.06) of PHT developing. CONCLUSION: US was an early marker of liver disease and more severe CF disease, a predictor of progressive liver disease. A controlled trial should be done to assess isolated US-detected disease as an indication for UDCA.     

Vitamin E status in children with cystic fibrosis and pancreatic insufficiency

Vitamin E status was compared in 69 children (7.0-10.0 years) with cystic fibrosis and pancreatic with the National Health and Nutrition Examination Survey III sample (6.0-11.9 years). With median vitamin E intakes of 6 mg/day (dietary) and 224 mg/day (supplemental), children with cystic fibrosis had higher serum alpha-tocopherol:cholesterol ratios, higher alpha-tocopherol, and lower cholesterol levels than in the National Health and Nutrition Examination Survey.